A complaint was made by a woman
about the services provided by two GPs to her daughter, who
suffered from severe anxiety and depression and committed suicide.
The complaint was on the grounds that the GPs prescribed
inappropriately, did not adequately involve the family, and failed
to recognise an adverse reaction. The woman also complained that
her daughter was not provided with sufficient information about the
options available for treatment and the risks and side effects of
the medications.

The Commissioner held that one GP
did not breach Right 6(1) as it was accepted that a variety of
treatment options had been discussed. While all the details were
not recorded in the notes, there was no evidence to suggest that
the GP did not provide sufficient information. The expert advice
was that a reasonable GP would not record all the details of the
information provided. It was also accepted that the original
prescriber of medications, in this case a psychiatrist, is
responsible for explaining the risks and benefits, adverse effects,
and withdrawal symptoms of the medications prescribed.

The GP also did not breach Right
4(1) because his decision to commence the patient on medication was
reasonable and it was not necessary for him to have delayed
treatment to further clarify her diagnosis. Furthermore, on the
basis of the information available to him at the time, which
included his view that the potential benefits of medication
outweighed the risks to the patient, the medications he prescribed
were appropriate and he took sufficient steps to ensure that the
patient was monitored. It was also the Commissioner's opinion that
it would have been inappropriate for the GP to involve the family,
unless the patient had specifically requested him to do so.

The complaint against the second GP
focused in part upon the decision to use clonazepam, a
benzodiazepine, to treat the patient's anxiety. It was complained
that this was not appropriate and that the GP failed to recognise
signs of dependence. The Commissioner held that this GP did not
breach Right 4(1) of the Code, even though clonazepam is only
formally indicated for epilepsy, as it can be used for other
purposes. The Commissioner was satisfied that clonazepam is an
appropriate drug to use for the treatment of anxiety, and that the
GP was following a widely accepted practice. Even though the GP
continued to prescribe clonazepam for about ten weeks before
recording that he was attempting to reduce her dose, his
prescription was appropriate because he was using less than the
maximum recommended dose, he was trying to reduce it and to change
to less addictive medication, and he was getting help from other
health professionals. The Commissioner also commented on the
difficulty of differentiating any possible signs of withdrawal from
benzodiazepines from symptoms and signs of pre-existing
anxiety.